Title: Section 709.13 - Adult day health-care programs

709.13 Adult day health-care programs. (a) This methodology will be utilized to evaluate certificate of need applications involving the initiation of adult day health-care programs. It is the intent of the State Hospital Review and Planning Council that this methodology, when used in conjunction with the planning standards and criteria set forth in section 709.1 of this Part, become a statement of planning principles and decisionmaking tools for directing the distribution of adult day health-care programs. The goals and objectives of the methodology expressed herein are expected to ensure that an adequate number of adult day health-care programs are available to provide access to care and avoid the unnecessary duplication of resources. Additionally it is intended that the methodology provide sufficient flexibility to consider additional circumstances that reflect on the need for adult day health care.

(b) The factors and methodology for determining the public need for adult day health care services in each county shall include, but not be limited to:

(1) An estimate of the capacity needed in adult day health-care programs to serve adult day health-care registrants. For purposes of this section, capacity means the number of registrants that an adult day health-care program can accommodate at one time based on factors such as availability of staff, furniture and equipment and the number and size of the rooms used for the program. This capacity is calculated using population estimates for each county projected five years in the future. This capacity shall be calculated using the following age cohorts and capacity measures:

(i) capacity for 0.04 registrants per 1,000 population aged 20-64;

(ii) capacity for 2.5 registrants per 1,000 population aged 65-74; and

(iii) capacity for 3.65 registrants per 1,000 population aged 75 and over.

(2) The estimates for each of the age cohorts shall be summed to derive the total capacity needed for adult day health-care services in a county.

(3) (i) To determine unmet need for adult day health-care program capacity in a county, capacity of the approved programs in such county shall be subtracted from the total capacity needed for such county.

(ii) The capacity of approved adult day health-care programs shall be deter mined as follows:

(a) for a program that was approved with a specific capacity, such approved capacity shall be utilized;

(b) for a program that was approved for a total number of registrants without a specific capacity, such number shall be divided by two to determine the program's capacity;

(c) for a program that was not approved with a specific capacity or for a total number of registrants, the department will determine, based on the most recently received and processed data, the total number of current registrants of such program and such number shall be divided by two to determine the program's capacity.

(iii) The number of registrants is divided by two in order to determine an approved program's capacity under clauses (ii) (b) and (c) of this paragraph, since it is estimated that each unit of adult day health-care program capacity will serve two registrants.

(4) In counties where the total capacity needed for adult day health-care services is less than the minimum capacity required in order to be approved under the operational standards set forth in Part 425 of this Title, one program may be approved despite such minimum capacity requirement, provided that all other criteria for approval are met.

(5) Notwithstanding that need may otherwise have been determined to be met under this section, additional adult day health-care program capacity may be ap proved within a county if:

(i) all existing programs within the county are operating at their approved capacities; and

(ii) there is evidence of further need for adult day health-care services as demonstrated by factors which include, but need not be limited to:

(a) waiting lists for adult day health-care services; and

(b) the number of people on alternate level of care in the county who could benefit from adult day health-care services.